The Muscle Strength of the Knee Joint after ACL Reconstruction Depends on the Number and Frequency of Supervised Physiotherapy Visits

Abstract

The aim of this study in anterior cruciate ligament reconstruction (ACLR) patients was to assess the effect of six months of supervised physiotherapy with a higher number of visits (SPHNV) compared to supervised physiotherapy with a lower number of visits (SPLNV) on the maximal peak torque (PT) and isometric torque (IT) of values obtained for hamstring (H) and quadriceps (Q) muscles of the knee joints under isokinetic and isometric conditions. Hypothesis: SPHNV improves IT and PT more than SPLNV. Group I had ACLR with a higher number of visits (n = 20), Group II had ACLR with a lower number of visits (n = 20), and Group III served as the control (n = 20). In Groups I and II, IT values were measured for quadriceps and hamstring muscles of the knee joints in the 13th and 24th weeks and for PT in the 18th and 24th weeks after ACLR (60 and 180 ⁰/s). In group III, the measurements were taken once. The isometric torque and isokinetic peak torque values were measured in N*m and they were normalized to body mass as relative IT (RIT) and relative PT (RPT) were expressed in N*m/kg. Results: In both ACLR groups, the RIT and RPT values obtained from the operated knee joints significantly increased in the 24 weeks following ACLR compared to the uninvolved side. Group II had significantly lower RIT and RPT values for quadriceps and hamstring muscles of the operated limbs compared with the uninvolved limbs (p = 0.008, p = 0.001). In group I, the larger number of visits positively correlated with the higher PT for quadriceps and hamstring muscles of the operated and uninvolved knees (from r = 0.506; p = 0.023 too r = 0.566; p = 0.009), respectively. Six months of SPHNV positively correlated with and improved the IT and PT values in patients after ACLR much more significantly than six months of SPLNV.

Twelve Weeks of a Staged Balance and Strength Training Program Improves Muscle Strength, Proprioception, and Clinical Function in Patients with Isolated Posterior Cruciate Ligament Injuries

“…In the study group, five subjects injured their dominant knee and five injured the non-dominant leg. There were no significant differences in age, body height, body weight, thigh circumference, initial knee range of motion and the level of daily physical activity (Tegner Activity Scale) [ 29 , 36 ] between the study group (before PCL injury) and the post-PCL reconstruction group (before test). After the end of 12 weeks training, the subjects in the study group declared that they could return to pre-injury physical activity.…”

“…The rehabilitation effect on the improvement of knee muscle strength between the injured knee and uninvolved knee to decrease leg asymmetry in patients with knee cruciate ligament injury is another concern [ 34 , 36 , 46 ]. Czamara et al [ 36 ] introduced a study to investigate the effect of the number and frequency of supervised physiotherapy visits on the knee muscle strength in patients after anterior cruciate ligament reconstruction (ACLR). They found that a lower number of visits in the ACLR group presented lower values of knee muscle strength in the operated leg compared to the uninvolved leg.…”

“…Each subject performed one test with 5 repetitions for a given angular velocity per second [ 34 , 35 ], and the highest PT value was recorded. The muscle strength value was recorded as the maximum PT and normalized by individual body weight to relative PT (N·m/kg) [ 36 ].…”

Ground Reaction Forces during Vertical Hops Are Correlated with the Number of Supervised Physiotherapy Visits after Achilles Tendon Surgery

“…In recent years, studies have focused on the assessment of the correlation between the time and number of supervised 6 month physiotherapy protocols with more visits (x = 74) that have been reported compared with supervised physiotherapy with fewer visits (x = 32) [54]. The results indicate a favorable effect of supervised physiotherapy with more visits on the reduction in the differences in relative vertical ground reaction force values and LSI of vertical ground reaction force values between the operated and the uninvolved leg, compared with the values obtained in the control group.…”

“…With reference to the previously mentioned results from patients after ACLR [22,54,55], supervised postoperative physiotherapy should be carried out within a longer postoperative period, which requires scientific evidence and, thus, further research.…”